The use of intravitreal injections of anti-Vascular Endothelial Growth Factor (anti-VEGF) has been used for a
broad spectrum of ocular pathologic entities. Although the dose of anti-VEGF agents used for treating eye disease is
minute compared with that used intravenously, intraocular administration can lead to systemic absorption and reduce
serum VEGF levels. Several systemic side effects, such as hypertension and cardiovascular complications have been
rarely reported in the literature.

Renal complications of intravenous administration of anti-VEGF, are well known and include a variety of renal
pathological damage which can induce proteinuria and hypertension.

We describe herein, 2 cases of diabetic patients with preexisting kidney disease who presented severe reduction of their
renal function after intraocular administration of anti-VEGF. Although a cause –effect correlation cannot be established
unless further studies are performed, we believe that pretreatment counseling should include a discussion outlining the
possible risk of aggravating of the renal function in patients with kidney disease. Close cooperation with the patient’s
nephrologist and close monitoring of the patient may be required, in such cases, in order to monitor the renal function
before and after the intravitreal administration of anti-VEGF.